Transcription

1 Internat. Marit. Health, 2008, 59, 1-4 INTERPOPULATION STUDY OF MEDICAL ATTENDANCE ABOARD A CRUISE SHIP RYSZARD TOMASZEWSKI, WACŁAW LESZEK NAHORSKI 1 ABSTRACT The study carried out aboard a cruise ship in the years involved ship passengers of various nationalities including 3872 Germans aged years and 1281 Americans aged years. Both nationality groups were divided into two age subgroups: till 64, and years. The German younger age subgroup (mean age 53,2 years) consisted of 59% of the passengers, whereas the years subgroup (mean age 72 years) was made up of 41% of the ship`s passengers. On the other hand, 73% of the Americans belonged to the years subgroup (mean age 73,4 years), whereas 27% to the younger one (mean age 52,8 years). The number of onboard consultations and their causes were determined. The occurrence of chronic illnesses in both years subgroups was assessed by means of a questionnaire. A higher frequency of consultations was found in the Germans (24,38%) than in the Americans (14,05%) (p = 0,001). The difference was particularly striking in the people over 65 years of age (30,87% of the Germans as compared with 14,22% of the Americans, p = 0,001). 1 Institute of Maritime and Tropical Medicine of the Medical University of Gdansk Powstania Styczniowego 9 B, Gdynia, Poland Fax , For correspondence: Prof. Ryszard Tomaszewski, MD, PhD, address as above 61

2 The Germans were nearly 4-times more frequently seen than the Americans for cardio-vascular and almost 3-times more often because of gastrointestinal disorders. The discrepancies in the consultation rates were mainly caused by the different insurance systems of both nations. Chronic illnesses as estimated by means of the questionnaire prevailed in the German passengers. The statistically significant differences (13,3% versus 20%, p = 0,01 and 0,001) regarded the locomotor system, urinary tract and a group of illnesses including neurological, ophthalmological, ear, skin, malignant and diabetes. INTRODUCTION The results of epidemiological studies constitute an important guidance determining application of the appropriate preventive and therapeutic measures. They also help solve crucial structural problems. Most studies have been carried out under stationary conditions involving homogenous or barely differentiated population groups. The onboard investigations were mainly focused on diarrheal disease outbreaks (1, 2), although some other topics were occasionally approached (3, 4, 5). The ship is an excellent place for such a study, her main adventage being identity of the living conditions. Thus the population differences observed aboard are primarily caused by external factors. During sea voyages differences in the medical consultation rates between Americans and Germans were noticed. Then a question arose of whether the reason consisted in the dissimilar states of health of people belonging to these two nations or in their different health insurance systems. Finding an answer was the purpose of this study. MATERIAL AND METHODS The study was performed on a passenger cruise ship sailing world-wide including the Antarctica. Out of a total of 161 cruises taken from 1993 through 1998, 45 were randomly selected. Thus the study population embraced 5153 passengers including 1281 Americans aged years and 3872 Germans aged years. The sex ratios of the nationality groups were comparable, a prevailing rate of the females being of about 10%. 62

3 Both nationality groups were divided into two age subgroups: till 64 and years. As many as 935 Americans (mean age 73,4 years) 73% belonged to the years subgroup, whereas 346 Americans (mean age 52,8 years) 27% to the younger one. The German younger age subgroup (mean age 53,2 years) consisted of 2285 passengers 59%, whereas 1585 persons (mean age 72 years) 41% were enrolled in the years subgroup. Ship`s physician`s records were used to determine the number of onboard consultations and their causes. Only the first consultation of every patient was considered, thus their total number correspond to the total number of onboard cases. To assess the occurrence of chronic illnesses in both years subgroups a questionnaire was conducted involving 150 subjects of each nationality (altogether 300 persons). The sex ratios in the questionnaire cohorts were 1:1. Comparisons were made using the Student t test. RESULTS A total of 180 Americans (14,05%) and 944 Germans (24,38%) were seen in the ship`s infirmary (Table 1). In the younger age subgroups (<64 years) 13,58% of the Americans and 19,86% of the Germans were attended. The difference in the consultation rates was particularly striking between the passengers who were over 65 years of age: as few as 133 Americans 14,22% were seen compared with 490 Germans 30,87%. All the differences were statistically significant (p = 0,01 0,001). Of note is that no diarrheal disease outbreak was recorded aboard. Table 1.-Frequency of onboard medical consultations of ship passengers in the nationality and age groups Consultations Americans Germans p No % No % Total Persons<64 years Persons>65 years , , , ,38 0,001 19,86 0,01 30,87 0,001 63

6 Table 3 shows that the Germans aged over 65 were much more frequently treated than the Americans. Manifold differences in the consultation rates were found regarding cardiovascular, gastrointestinal, locomotor system disorders, seasickness and a group of other as neurological, ophthalmological, ear, skin, malignant and diabetes. All the differences were statistically significant (p = 0,001). Trauma-related conditions were also more frequently seen in the Germans. Results of the questionnaire about the prevalence of chronic illnesses in the subjects over 65 years of age are indicated in Table 4. All kinds of were more frequently found among the Germans. Statistically significant differences (p = 0,01 0,001) in the incidence rates regarded locomotor system, urinary disorders and the group of other. DISCUSSION The observed differences in the consultation rates between Americans and Germans and especially in people over 65 years of age deserve attention. Two causes could have contributed to this effect: 1) dissimilar states of health of these nations, 2) different health insurance systems. In order to tackle the first possibility a questionnaire was conducted in both years subgroups involving 150 subjects of each nationality. Its aim was to determine the incidence rate of chronic illnesses as a morbidity difference index. A higher prevalence of all conditions was found in the Germans. The biggest differences (13,3% versus 20%, p = 0,01 and 0,001) regarded locomotor system and urinary tract disorders as well as the group of other (neurological, ophthalmological, ear, skin, malignant and diabetes). The differences in the incidence rates of respiratory, gastrointestinal and cardiovascular varied from 1,3% to 8,7% and were statistically insignificant. On the other hand the consultation rates showed the highest discrepances just in these disease groups. The Germans were nearly 4-times more frequently seen than the Americans due to cardiovascular and almost 3-times more often because of gastrointestinal disorders. Of note is that 73% of the Americans belonged to the years subgroup compared with only 41% of the Germans. Thus the results suggest that the discrepancies in the consultation rates can be accounted for by merely dissimilar states of health of both nations. This conjecture is favoured by a higher, although statistically insignificant attendance rate in the Germans due to trauma-related 66

7 conditions. Similar consultation rates for urinary tract disorders in spite of a 2-fold difference in their prevalence as revealed by the questionnaire also support the above suggestion. Other findings, although less spectacular are as well in favour of this viewpoint. A nearly 2-fold difference in the frequency of locomotor system disorders was associated with an almost 5-fold discrepancy in the consultation rates. A similar relation concerned the group of the other. A clinching argument in this respect is the frequency of consultations for seasickness which was 3-times higher in the Germans. This finding might partly have been influenced by the fact that some Americans would wear the scopolamine patches (Transderm Scop discs), the production of which in Europe by CIBA Geigy was discontinued. Although the consultation rates, for many conditions in the younger age subgroups were similar, their total percentage prevailed in the Germans (19,86% as opposed to 13,58%, p =0,01). An essential distinguishing feature between both nations was the health insurance system. The Americans had a basic insurance that would assume standard medical care carrying a low level of cover. On the other hand the Germans who took out a comprehensive private insurance were entitled to a wide range of refundable medical services. Thus, the health insurance system can, to a large extent, influence the patient`s decision to apply for medical attendance. Interpopulation studies highly contribute to our improved understanding of various phenomena. The ship constitutes an excellent model for such purposes because of the homogenous, secluded milieu she provides. This study is to the best knowledge of authors the first interpopulation investigation carried out in such a model. CONCLUSIONS 1. The differences in the frequency of consultations found between Americans and Germans, and especially in people above 65 years of age were mainly caused by their different insurance systems. 2. The differences in the incidence rates of chronic illnesses revealed by the questionnaire in the subjects aged above 65 years are hardly explicable and can become an investigation topic. 67

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

American Epilepsy Society 1 Epilepsy 101 for nurses has been developed by the American Epilepsy Society to prepare professional nurses to understand the general issues, concerns and needs of people with

No. of dogs Chesapeake Bay Retriever Club Chesapeake Health Survey Results This health survey is the first of a two-part survey of Chesapeake Bay Retrievers in the UK, carried out by the Chesapeake Bay

Academy of Life Underwriting Education Program Curriculum ALU CURRICULUM The ALU curriculum offers study materials and a series of ALU exams which allow a student to gain a broad understanding of the requirements

REGULATIONS FOR THE DEGREE OF MASTER OF CLINICAL PHARMACY (MClinPharm) (See also General Regulations) MCP1 Definition The degree of Master of Clinical Pharmacy (MClinPharm) is a postgraduate degree awarded

Dear New Patient, Thank you for making an appointment with our office. We look forward to serving your visual needs. Enclosed you will find our New Patient Questionnaires. Please complete these and fax

Part Burden of disease:. Broad cause composition 0 5. The age distribution of burden of disease 6. Leading causes of burden of disease 7. The disease and injury burden for women 6 8. The growing burden

eappendix A. Summary for Preoperative ECG American College of Cardiology/ American Heart Association, 2007 A1 2002 A2 European Society of Cardiology and European Society of Anaesthesiology, 2009 A3 Improvement,

Internat. Marit. Health, 2008, 59, 1-4 INFLUENZA AS A HEALTH PROBLEM OF SEA TRAVELLERS ANETA NITSCH-OSUCH 1 ABSTRACT Traveling people may play an important role in spreading of influenza viruses in the

High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

Dallas Neurosurgical and Spine Associates, P.A Patient Health History DOB: Date: Reason for your visit (Chief complaint): Past Medical History Please check corresponding box if you have ever had any of

Flu jab 2015 Your doctor or GP will invite you to attend for a flu jab. This leaflet contains details about the flu jab The best time to get a flu jab is from mid-october to mid-november. You will be given

The Hebrew University-Hadassah Braun School of Public Health & Community Medicine APPLICATION FOR ADMISSION TO THE INTERNATIONAL MPH PROGRAM PART A This application form must be accompanied by the following

1080 e-health For Continuity of Care C. Lovis et al. (Eds.) 2014 European Federation for Medical Informatics and IOS Press. This article is published online with Open Access by IOS Press and distributed

Research Journal of Pharmaceutical, Biological and Chemical Sciences Prevalence of Microalbuminuria in relation to HbA1c among known Type2 Diabetic Patients in Puducherry population Muraliswaran P 1 *,

Snap shot Cross-sectional surveys FETP India Competency to be gained from this lecture Design the concept of a cross-sectional survey Key areas The concept of a survey Planning a survey Analytical cross-sectional

Turner Syndrome Introduction Turner syndrome is a genetic disorder that affects a girl's development. Girls who have it are short, and most are infertile. Girls and women with Turner syndrome are at risk

THE GEORGE INSTITUTE FOR GLOBAL HEALTH Antiocoagulation in diabetes and CKD Vlado Perkovic Executive Director, George Institute Australia Professor of Medicine, University of Sydney Affiliated with the

Preview: Post-class quiz 5 - Clinical Trials Question 1 What is meant by "randomization"? (Select the one best answer.) Question 2 A. Selection of subjects at random. B. Randomization is a method of allocating

The rate of failure to thrive among children aged 2 months - 5 years in Kanaan sub-district / Diyala province Mehdi SH. Al-Zuheiry (M.B.Ch.B., F.I.C.M.S.Ped.) College of Medicine-Diyala University Background:

The Changing Health Needs of Syrian Refugees in the Region Fouad M. Fouad MD American University of Beirut Responding to Changing Health Needs in Complex Emergencies Workshop on Refugee Health Point Hotel,

Health Information: Priorities in the Work Plan 2006 DG SANCO Unit C-2 Health Information Luxembourg Our objectives (I) The purpose of the European Union Health Information System is to provide quality,

PAYMENT AGREEMENT: We accept most insurance plans as a courtesy. We encourage you to familiarize yourself with your individual plan. Insurance coverage is an agreement between patient and insurance company

CHS Graduate Student & in Description Additional Admission MSc PhD MSc Healthcare MSc Clinical is the study of the distribution of diseases in populations and of factors that influence the occurrence of

PRACTICE INFORMATION SHEET Study title A feasibility study for a cluster randomised trial of text messaging reminders for influenza vaccine in patients under 65 in clinical risk groups in English primary

DISEASE STATE REVIEW Course of Frequent/Daily Headache in the General Population and in Medical Practice Egilius L.H. Spierings, MD, PhD, Willem K.P. Mutsaerts, MSc Department of Neurology, Brigham and

USF Eye Institute and Ear, Nose and Throat Center Neuro-Opthamalogy Dear Neuro-ophthalmology Patients: The following information is to prepare you for your visit with Dr. Drucker. If you have had an MRI,

Current research on health effects of extreme heat adelaide.edu.au PARAMEDICS AUSTRALASIA 29 November 2012 Dr Alana Hansen Overview Background Heat and health International research Heatwaves around the

Part 3 Disease incidence, prevalence and disability 9. How many people become sick each year? 28 10. Cancer incidence by site and region 29 11. How many people are sick at any given time? 31 12. Prevalence

WMDA Policy Statement on the Utility of Autologous or Family Cord Blood Unit Storage The WMDA Board adopted this policy on 25 th of May 2006. Policy updated _April 2011 The Cord Blood Working Group and

Government of Newfoundland and Labrador Department of Health and Community Services IMPORTANT NOTICE May 2013 13-07 TO: ALL PHYSICIANS RE: REVISED MCP PAYMENT SCHEDULE EFFECTIVE JUNE 1, 2013 REVISED ALTERNATE

SUPPLEMENT 1: (Supplementary Material for online publication) Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers About this

SAMPLE ASSESSMENT TASKS HEALTH STUDIES ATAR YEAR 11 Copyright School Curriculum and Standards Authority, 2014 This document apart from any third party copyright material contained in it may be freely copied,

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this

WMDA Policy Statement for the Utility of Autologous or Family Cord Blood Unit Storage (This policy statement has been approved and adopted by the WMDA board on the 25 th of May 2006) The Cord Blood Registries